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Purpose: Indirect inguinal hernia is a common manifestation in childhood related to the patency of the processus vaginalis. We have been performing the correction of this condition through the laparoscopic approach since April 2003. In this retrospective review we show our results in terms of safety, pain and diagnostic accuracy of the minimally invasive approach. Methods: 636 patients underwent laparoscopic inguinal repair from April 2003 to April 2012. We compared our results with the ones reported in the scientific literature. The difference between the clinical diagnosis and the operative finding in terms of unilateral or bilateral hernia was evaluated. The incidence sorted by age and recurrence was calculated. Results: 636 patients (496 males and 140 females) aged between 15 days and 16 years (average age 3.85), underwent laparoscopic inguinal hernia correction. The hernia sac was empty in 531 cases (83.4%), ileo-blind in 25 cases (3.9%), ovarian hernia in 29 cases (4.5%), hydrocele 24 in cases (3.7%), cysts cord in 17 cases (2.6%), direct hernia 6 in cases (0.9%), omentum 4 in cases (0.6%). Preoperative diagnosis show that 445 patients (70%) had unilateral patent processus vaginals: 285 were right (64%) and 160 were left (36%); 191 (30%) were bilateral. The intraoperative evaluation showed that 370 were monolateral (58%) and 266 (42%) were bilateral. Three main groups were identified on the basis of age distribution: group A patients with an age lower than 6 months (186, 29%), group B patients aged between 6 months and 5 years (330, 52%), and group C patients, which were more than 5 years old (120, 19%). Three (1.1%) inguinal recurrences occurred in group A, 13 (4.1%) recurrences occurred in group B and 9 (7.5%) in group C. Our follow-up was between 6 months and 10 years, we have 24 recurrences (3.7%) all re-operated by laparoscopy. Conclusion: The laparoscopic approach to inguinal hernia makes it possible to have a complete vision of the abdominal anatomy giving the chance to correct misunderstood defects. Our experience shows that laparoscopic inguinal repair is now a safe procedure and can be suggested as the gold standard in dedicated paediatric surgical units where surgeons are well trained.

Minimally invasive surgery has been one of the most important advances in surgery in the last century. This approach ensures the reduction of morbidity, post-operative pain, adhesions and scarring by reducing the incisions to small punctures. Nowadays almost all paediatric operations have an endoscopic surgical variant. Although the use of minimally invasive surgery in older children has expanded steadily over the past decade, it has not been used widely in newborn due to their small size and concern about the impact of carbon dioxide pneumoperitoneum on cardiopulmonary function. In the last ten years, technical innovations and advancement in instrumentation have made endoscopic procedures safer and easier in newborns. Actually minimally invasive surgery is being performed in both the neonatal chest and abdomen. Congenital neonatal deformities including esophageal atresia, congenital diaphragmatic hernia, congenital pulmonary cystic lesions, small bowel atresia, ano-rectal malformations, ovarian cysts, Hirschsprung Disease and malignancies are now being managed with endoscopic surgery.